There is debate in the medical community over whether undetected gastroesophageal reflux (GER) — a condition caused by acid coming up from the stomach into the esophagus — could contribute to inadequate asthma control in children taking inhaled steroids.

According to new research conducted by the American Lung Association Asthma Clinical Research Centers Network (ALA-ACRC), published Jan. 24 in the Journal of the American Medical Association, adding prescription acid controllers to standard inhaled steroid treatment does not improve asthma symptoms or control in children.

Washington University School of Medicine in St. Louis participated in this research as a clinical center. Leonard B. Bacharier, MD, professor of pediatrics who treats children with asthma and allergies at St. Louis Children’s Hospital, and Mario Castro, MD, professor of medicine who treats patients with asthma at Barnes-Jewish Hospital, led the study at the Washington University site.

“Proton pump inhibitors (PPIs) are often prescribed to children with asthma even in the absence of reflux symptoms in an attempt to improve their asthma control,” Bacharier says. “Unfortunately, very little high-quality evidence was available to determine if this approach was truly effective. This study was therefore conducted to determine if PPIs are effective in treating asthma in children without typical reflux symptoms.”

BacharierThe results of this study are considered to be the most comprehensive evaluation to date of the effectiveness of prescription acid controllers to improve asthma symptoms and control among children. These results are similar to those found in a previous ALA-ACRC study, which examined the relationship between asthma and GER among adults. That study was published in the New England Journal of Medicine in 2009.

In the latest ALA-ACRC trial, 360 children aged 6-17 with poorly controlled asthma and without symptoms of GER were randomly assigned to receive a daily dose of either lansoprazole, a class of drugs that suppresses the production of stomach acid, or an inactive placebo pill in addition to their inhaled steroid therapy. Compared with placebo, children who received lansoprazole did not show signs of improved lung function or a decrease in asthma symptoms. However, children who took lansoprazole had an increased risk of adverse effects, notably sore throats and bronchitis.

CastroAsthma and GER are common disorders in children, and symptoms of GER such as “heartburn,” vomiting and difficulty swallowing are frequently reported among children with asthma. Approximately 40 percent of participants in the ALA-ACRC trial were identified as having GER.

“Prescription acid control medications are costly; those with asthma can spend as much as $1.1 billion per year,” says Norman H. Edelman, MD, chief medical officer of the American Lung Association. “Knowing that silent acid reflux does not play a significant role in poor asthma control is the kind of practical research that is helpful immediately for both physicians and patients alike. Talk with your doctor before discontinuing any medication, as each patient’s specific needs will vary.”

Takeda Pharmaceuticals and GlaxoSmithKline provided the medication for the study, which was funded by the American Lung Association and the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH).

The ACRC Network is an American Lung Association-sponsored research program that conducts large-scale clinical trials with the mission of advancing the care and treatment of people with asthma.

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

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